内科综合疗法治疗食管静脉曲张破裂出血探讨

Esophageal Variceal Ligation Combined with the Integrated Drug Treatment of Esophageal Variceal Bleeding

目的探讨以内镜下食管静脉曲张套扎术(EVL)为主的术后内科综合治疗对食管静脉曲张(esophagealvarices,EV)出血的止血和防止再出血的疗效。方法43例患者EVL术前给予奥曲肽,术后给予质子泵抑制剂、胸腺蛋白(欣洛维)、普萘洛尔等处理,与37例进行EVL治疗后仅给予质子泵抑制剂处理作对照。结果以EVL为主的术后内科综合治疗组一次性止血成功率91%,对照组为78%,均较高,二者无明显差异(P>0.05),但1个月再出血率EVL为主的术后内科综合治疗组为7%,对照组为30%,二者有明显差异(P<0.05),1个月治疗后胃黏膜糜烂治愈率术后内科综合治疗组高于对照组(P<0.01),1年和3年的再出血及病死率明显低于对照组。结论 EV出血行EVL治疗,一次止血成功率高,术后给予质子泵抑制剂、胸腺蛋白、普萘洛尔行综合治疗,治疗门脉高压性胃黏膜糜烂有明显疗效,预防EV破裂再出血,安全有效,并可降低病死率。

Objective To investigate the ef ect of esophageal variceal ligation(EVL)combined with the integrated drug treatment of esophageal variceal bleeding and the prevention of rebleeding.Methods 80 cases were randomly divided into control group and combined therapy group.Two groups were both treated with EVL.Combined therapy group was treated with octreotide before EVL and treated with PPI,thymus protein oral solution and propranolol after EVL.Control group was only treated with PPI after EVL.Results There was no significantly difference in ef ect rate of tesophageal variceal bleeding between the combined therapy group and the control group.On 1 month,1 year and 3 year after operation,the combined therapy group in re-bleeding rate was significantly lower than that in the control group,so was the rate of death in 1 year and 3 year.And the cure rate of gastricmucosa erosion in portal hypertensive gaseropathy in the combined therapy group is much higher than that in the control group.Conclusion EVL is ef evtive in esophageal variceal bleeding.EVL combined with the integrated drug treatment has significantly ef ects in portal hypertensive gaseropathy and the prevention of rebleeding,and lower the rate of death.